236 DISEASES OF THE LIVER 



hepatitis is a more advanced stage. As a rule the symptoms 

 are more intensive than in acute congestion. Nausea and 

 vomiting are more pronounced and usually more persistent; 

 the vomited material often contains a quantity of bile color- 

 ing the material a greenish color. Blood may be vomited 

 up along with the other material, from the irritation of the 

 mucous membrane. Constipation is nearly always present. 

 At certain periods in the course of the disease diarrhea 

 may appear. The fecal discharges are very fetid, yellowish 

 or clay colored. Icterus, noticeable on the conjunctiva, 

 mucous membrane of the moUth, and sometimes in the non- 

 pigmented skin, will be a prominent symptom. The liver is 

 found enlarged and sensitive on palpation. 



The urine is usually concentrated, highly colored, of 

 increased specific gravity, and contains a high percentage 

 of urates and uric acid as well as bile pigment. 



The temperature in the early stages of acute hepatitis is 

 usually quite materially elevated (103-104° F.). The fever 

 temperature assists in differentiating the condition from 

 simple congestion. However, in the later stages, the tem- 

 perature may be found normal, or even subnormal, due to 

 retained toxins, bile salts, etc. The general symptoms are 

 dullness, intense thirst, and gastro-intestinal disturbance. 



Diagnosis.— The diagnosis depends on the causes, the 

 elevation of temperature, the enlargement and sensitiveness 

 of the liver, and the general symptoms. To distinguish 

 between acute congestion and inflammation of the liver is 

 difficult and depends upon the severity of the symptoms. 



Prognosis. —The prognosis is unfavorable. In some of the 

 milder cases recovery takes place, but when advanced it 

 nearly always proves fatal. 



Treatment.— The treatment for active congestion of the 

 liver is applicable. (See Active Congestion of the Liver.) 



In chronic hepatitis treatment is valueless. 



Suppurative Hepatitis.— Abscess of the Liver. —Definition. 

 —An inflammation of the liver resulting in abscess formation, 

 which occurs under a variety of circumstances and in several 

 forms. Liver abscesses are commonly divided into two kinds : 

 (a) The large single abscess; (b) the small multiple abscess. 



